- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,677.35 / $12,589.25
| Facility | | $1,445.44 | $4,677.35 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,584.89 / $3,981.07
| Professional | | $1,230.27 | $1,584.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $33,113.11
| Facility | | $4,677.35 | $13,803.84 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $3,311.31
| Professional | | $1,122.02 | $1,778.28 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,890.45 / $11,748.98
| Facility | | $758.58 | $3,890.45 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $4,265.80
| Professional | | $1,348.96 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,019.95
| Professional | | $1,148.15 | $1,621.81 | $3,019.95 |